Retrospective Analysis Of Different Intervention Strategies Among Patients With Left Main Versus Non-left Main Bifurcation Lesion

Objective:Retrospective analysis the prognostic impacts of different intervention strategies among patients with left main (LM) and non-left main (NLM) bifurcation lesions on clinical outcomes to explore whether should we consider the anatomical location of the lesion when treating the bifurcation lesion so as to guide the optimal clinical treatment of coronary bifurcation lesions.Methods:Clinical datas of patients with bifurcation lesions treated only with drug-eluting stents (DES) of Shandong Provincial Hospital from January2007to January2012were collected and analyzed retrospectively. The inclusion criteria is patients the coronary with bifurcation lesions,and the trunk vessel diameter≥2.5mm, the side branch vessel diameter≥2.0mm. The patient’s clinical data, including (1) clinical features,(2) coronary angiography characteristics,(3) follow-up of major adverse cardiac events (MACE) occurred. The patients were divided into two groups: single stenting group and double stenting group according to the finally quantity of stents dealing with bifurcation lesion. Besides, the patients were also divided into left main bifurcation lesions group and non-left main bifurcation lesions group according to anatomical location of the lesion. Finally SPSS17.0statistical software were used for statistical analysis and p<0.05was considered statistically significant.Results:(1)450patients including472bifurcation lesions were enrolled, of which139were left main bifurcation lesions,333were non-left main bifurcation lesions. Two stent strategy was used more frequently in the LM bifurcation group than in the non-LM bifurcation group (41.2%vs21.2%p<0.01).Besides, patients with Left main bifurcation lesions dealing with double stents were older (p=0.05)and more likely manifested acute coronary syndrome (p=0.000).(2)The angiographic data show that patients with non-left main bifurcation lesions dealing with double stents had a highest incidence of anterior descending artery bifurcation lesions. In both left main and non-left main bifurcation lesions group, The SYNTAX score in double stent group was significantly higher than the single stent group which suggests the double stent group were concluding more complex lesions, The angiographic datas also show the double stent group always accompany with more multivessel disease, more true bifurcation lesions and a higher degree of side vascular diameter stenosis before PCI..(3) During a follow-up of24months, in non-left main group,the incidence of myocardial infarction, cardiac death, target lesion rebuilt were basically the same in both the single stent and double stent groups. Conversely, in patients with LM bifurcation lesions, the double stent strategy was associated with a higher incidence of major adverse cardiovascular events (p=0.0003), myocardial infarction and target vessel revascularization, but there was no significant difference in terms of cardiac death.Conclusion:(1)When making the optimal strategy of bifurcation lesions,we should take the anatomical location of the lesion into account, and carefully assessthe complexity of the patient’s lesions.(2) The single stent strategy,if possible, should be considered the preferred approach for the treatment of coronary bifurcation lesions。(3) Considering the higher risk of the major adverse cardiac events observed in patients treated with the double stent technique,a careful surgical evaculation should take place in patients with LM bifurcation lesions requiring an elective double stent technique.